PENGARUH PEMBERIAN ANTIBIOTIK PROFILAKSIS TERHADAP LUARAN BEDAH PADA PASIEN GERIATRI: SISTEMATIK REVIEW
Abstrak
Tinjauan sistematis ini mengkaji efektivitas pemberian antibiotik profilaksis dalam menurunkan risiko infeksi luka operasi pada pasien geriatri. Topik ini sangat penting secara global mengingat peningkatan pesat populasi lansia yang rentan terhadap komplikasi pasca operasi, serta variabilitas bukti yang masih ada terkait efektivitas dan durasi optimal antibiotik profilaksis. Meskipun banyak studi telah dilakukan, belum ada sintesis bukti terbaru yang komprehensif untuk mengisi gap tersebut. Studi ini, yang merupakan tinjauan sistematis berdasarkan pedoman PRISMA 2020, menganalisis artikel dari basis data Scopus, PubMed, dan Google Scholar (2020-2025). Studi ini melibatkan 31 artikel yang memenuhi kriteria inklusi, termasuk studi observasional retrospektif dan uji klinis acak, dengan outcome utama infeksi pasca operasi dan efek samping terkait antibiotik. Metode analisis meliputi evaluasi kualitas studi serta sintesis naratif dan kuantitatif. Hasil menunjukkan pemberian antibiotik profilaksis secara tepat signifikan mengurangi risiko infeksi, khususnya pada operasi risiko tinggi seperti kolorektal, ortopedi, dan kardiotoraks, dengan durasi optimal sekitar 24 jam pasca operasi. Risiko resistensi antibiotik dan infeksi oportunistik tetap menjadi perhatian utama. Implikasi praktisnya menuntut pengembangan pedoman berbasis bukti dengan penyesuaian durasi pemberian serta penguatan strategi pencegahan alternatif. Penelitian lanjutan dengan desain uji klinis acak multicenter sangat penting untuk mengoptimalkan regimen profilaksis pada populasi lansia yang beragam dan kompleks.
Referensi
Aceto, P. et al. (2020) ‘Perioperative Management of Elderly patients (PriME): recommendations from an Italian intersociety consensus’, Aging Clinical and … [Preprint]. Springer. Available at: https://doi.org/10.1007/S40520-020-01624-X.
Achilli, P. et al. (2020) ‘Preoperative immunonutrition in frail patients with colorectal cancer: an intervention to improve postoperative outcomes’, International Journal of … [Preprint]. Available at: https://doi.org/10.1007/s00384-019-03438-4.
Assil, K.K. et al. (2021) ‘Dropless cataract surgery: modernizing perioperative medical therapy to improve outcomes and patient satisfaction’, Current opinion in … [Preprint]. journals.lww.com. Available at: https://journals.lww.com/co-ophthalmology/fulltext/2021/01001/Dropless_cataract_surgery__modernizing.1.aspx.
Aykac, A. and Baran, O. (2020) ‘Safety and efficacy of retrograde intrarenal surgery in geriatric patients by age groups’, International Urology and Nephrology [Preprint]. Available at: https://doi.org/10.1007/s11255-020-02564-1.
Bell, J. et al. (2020) ‘Clostridium difficile infection following spine surgery: incidence, risk factors, and association with preoperative antibiotic use’, Spine [Preprint]. Available at: https://journals.lww.com/spinejournal/fulltext/2020/11150/Clostridium_difficile_Infection_Following_Spine.13.aspx.
Carl, J. et al. (2020) ‘Effect of postoperative oral antibiotics on infections and wound healing following foot and ankle surgery’, Foot &Ankle … [Preprint]. Available at: https://doi.org/10.1177/1071100720946742.
Carney, T.J. et al. (2023) ‘Advancing Chronic Disease Practice Through the CDC Data Modernization Initiative’, Preventing Chronic Disease, 20, p. 230120. Available at: https://doi.org/10.5888/pcd20.230120.
Colyn, E., Herawati, F. and Yulia, R. (2020) ‘Studi Literatur tentang Kuantitatif Penggunaan Antibiotik pada Bangsal Bedah dengan DDD’, KELUWIH: Jurnal Kesehatan dan Kedokteran, 2(1), pp. 9–22. Available at: https://doi.org/10.24123/kesdok.V2i1.2975.
Fitratiara, D., Puspitasari, I. and Nuryastuti, T. (2022) ‘Evaluasi Kesesuaian Penggunaan Antibiotik Profilaksis Terhadap Kejadian Infeksi Luka Operasi Pada Pasien Bedah Digestif di Salah Satu Rumah Sakit Tipe B Kabupaten Sleman’, Majalah Farmaseutik, 18(2). Available at: https://doi.org/10.22146/farmaseutik.v1i1.63691.
Ginaldi, L. et al. (2001) ‘Immunosenescence and infectious diseases’, Microbes and Infection, 3(10), pp. 851–857. Available at: https://doi.org/10.1016/S1286-4579(01)01443-5.
Gjorgjievski, M. and Ristevski, B. (2020) ‘Postoperative management considerations of the elderly patient undergoing orthopaedic surgery’, Injury, 51, pp. S23–S27. Available at: https://doi.org/10.1016/j.injury.2019.12.027.
Guan, X.-S. et al. (2021) ‘Long-term prophylactic intravenous antibiotics after Kasai portoenterostomy for biliary atresia do not reduce the risks of post-operative cholangitis, a retrospective study’, Translational Pediatrics, 10(8), pp. 2076–2082. Available at: https://doi.org/10.21037/tp-21-309.
Habib, A.M. et al. (2019) ‘Postoperative prophylactic antibiotics for facial fractures: A systematic review and meta‐analysis’, The Laryngoscope, 129(1), pp. 82–95. Available at: https://doi.org/10.1002/lary.27210.
Karabulut, Z. et al. (2021) ‘What should be done for perforation of the gallbladder during laparoscopic cholecystectomy: prophylaxis or treatment?’, … & Advanced Surgical … [Preprint]. Available at: https://doi.org/10.1089/lap.2020.0322.
Le, J. et al. (2020) ‘Surgical site infection following traumatic orthopaedic surgeries in geriatric patients: incidence and prognostic risk factors’, International wound … [Preprint]. Available at: https://doi.org/10.1111/iwj.13258.
Liu, D. et al. (2020) ‘Short-term outcomes and prognosis of laparoscopy-assisted total gastrectomy in elderly patients with stomach cancer’, Surgical … [Preprint]. Available at: https://doi.org/10.1007/s00464-019-07338-0.
Mazza, F. et al. (2020) ‘Enhanced recovery after surgery: adherence and outcomes in elderly patients undergoing VATS lobectomy’, … cardiovascular surgery [Preprint]. Available at: https://doi.org/10.1007/s11748-020-01331-4.
Meng, Y., Zhao, P. and Yong, R. (2021) ‘Modified frailty index independently predicts postoperative pulmonary infection in elderly patients undergoing radical gastrectomy for gastric cancer’, Cancer management and research [Preprint]. Available at: https://doi.org/10.2147/CMAR.S336023.
Menz, B.D. et al. (2021) ‘Surgical antibiotic prophylaxis in an era of antibiotic resistance: common resistant bacteria and wider considerations for practice’, Infection and drug … [Preprint]. Available at: https://doi.org/10.2147/IDR.S319780.
Millan, M. and Renau-Escrig, A.I. (2020) ‘Minimizing the impact of colorectal surgery in the older patient: the role of enhanced recovery programs in older patients’, European Journal of Surgical Oncology [Preprint]. Available at: https://www.sciencedirect.com/science/article/pii/S0748798319315112.
Motaghi, S. et al. (2024) ‘Antibiotic prophylaxis for the prevention of surgical site infections following colorectal surgery: protocol for network meta-analysis of randomized trials’, Systematic Reviews, 13(1), p. 224. Available at: https://doi.org/10.1186/s13643-024-02639-5.
Musavi, L. et al. (2020) ‘Infectious complications after open cranial vault remodeling for craniosynostosis’, … Craniofacial Surgery [Preprint]. Available at: https://journals.lww.com/jcraniofacialsurgery/fulltext/2020/01000/Infectious_Complications_After_Open_Cranial_Vault.11.aspx.
Neuerburg, C.K.F. et al. (2024) ‘Antibiotic Prophylaxis During Allogeneic Stem Cell transplantation—A Comprehensive Single Center Retrospective Analysis’, Transplantation and Cellular Therapy, 30(12), pp. 1195.e1-1195.e13. Available at: https://doi.org/10.1016/j.jtct.2024.09.011.
Ohge, H. et al. (2021) ‘The Japan Society for Surgical Infection: guidelines for the prevention, detection, and management of gastroenterological surgical site infection, 2018’, Surgery Today, 51(1), pp. 1–31. Available at: https://doi.org/10.1007/s00595-020-02181-6.
Page, M.J. et al. (2021) ‘The PRISMA 2020 statement: An updated guideline for reporting systematic reviews’, The BMJ, 372. Available at: https://doi.org/10.1136/bmj.n71.
Pak, H. et al. (2020) ‘Surgical complications in colorectal cancer patients’, … of medicine and surgery [Preprint]. Elsevier. Available at: https://www.sciencedirect.com/science/article/pii/S2049080120300583.
Park, Y. et al. (2020) ‘Clinical outcomes of octogenarians according to preoperative disease severity and comorbidities after laparoscopic cholecystectomy for acute cholecystitis’, Journal of Hepato … [Preprint]. Available at: https://doi.org/10.1002/jhbp.719.
Pastena, M. De et al. (2021) ‘Antibiotic prophylaxis with piperacillin–tazobactam reduces post-operative infectious complication after pancreatic surgery: an interventional, non-randomized study’, Surgical … [Preprint]. Available at: https://doi.org/10.1089/sur.2020.260.
Podda, M. et al. (2021) ‘Multidisciplinary management of elderly patients with rectal cancer: recommendations from the SICG (Italian Society of Geriatric Surgery), SIFIPAC (Italian Society of Surgical Pathophysiology), SICE (Italian Society of Endoscopic Surgery and new technolog’, World Journal of Emergency Surgery. Springer. Available at: https://doi.org/10.1186/s13017-021-00378-9.
Polla, G. Della et al. (2020) ‘Preoperative antibiotic prophylaxis in elective minor surgical procedures among adults in southern Italy’, Antibiotics [Preprint]. mdpi.com. Available at: https://www.mdpi.com/2079-6382/9/10/713.
Rodriguez-Pardo, D. et al. (2021) ‘Periprosthetic joint infection prophylaxis in the elderly after hip hemiarthroplasty in proximal femur fractures: insights and challenges’, Antibiotics [Preprint]. mdpi.com. Available at: https://www.mdpi.com/2079-6382/10/4/429.
Rohrer, F. et al. (2021) ‘Prolonged antibiotic prophylaxis use in elective orthopaedic surgery–a cross-sectional analysis’, BMC musculoskeletal … [Preprint]. Springer. Available at: https://doi.org/10.1186/s12891-021-04290-w.
Rutenberg, T.F. et al. (2020) ‘Antibiotic prophylaxis as a quality of care indicator: does it help in the fight against surgical site infections following fragility hip fractures?’, … and Trauma Surgery [Preprint]. Available at: https://doi.org/10.1007/s00402-020-03682-2.
Savage, T.J. et al. (2023) ‘Treatment Failure and Adverse Events After Amoxicillin-Clavulanate vs Amoxicillin for Pediatric Acute Sinusitis’, JAMA, 330(11), p. 1064. Available at: https://doi.org/10.1001/jama.2023.15503.
Schneider, P. et al. (2021) ‘Prophylactic Antibiotic Regimens In Tumor Surgery (PARITY): a multi-center randomized controlled study comparing alternative antibiotic regimens in patients undergoing tumor resections with endoprosthetic replacements—a statistical analysis plan’, Trials, 22(1), pp. 1–14. Available at: https://doi.org/10.1186/s13063-021-05147-2.
Segala, F. V et al. (2020) ‘Antibiotic appropriateness and adherence to local guidelines in perioperative prophylaxis: results from an antimicrobial stewardship intervention’, … Resistance &Infection … [Preprint]. Springer. Available at: https://doi.org/10.1186/s13756-020-00814-6.
Shen, J. et al. (2020) ‘Prognostic implications of preoperative pneumonia for geriatric patients undergoing hip fracture surgery or arthroplasty’, Orthopaedic Surgery [Preprint]. Available at: https://doi.org/10.1111/os.12830.
Tarchini, G., Liau, K.H. and Solomkin, J.S. (2017) ‘Antimicrobial Stewardship in Surgery: Challenges and Opportunities’, Clinical Infectious Diseases, 64(suppl_2), pp. S112–S114. Available at: https://doi.org/10.1093/cid/cix087.
Vincentis, A. De et al. (2021) ‘Orthogeriatric co-management for the care of older subjects with hip fracture: recommendations from an Italian intersociety consensus’, Aging Clinical and … [Preprint]. Available at: https://doi.org/10.1007/s40520-021-01898-9.
who (2016) World Population Prospects; Department of Economic and Social Affairs Population Division.
Yang, J. et al. (2021) ‘Reduction of risk of infection during elective laparoscopic cholecystectomy using prophylactic antibiotics: a systematic review and meta-analysis’, Surgical Endoscopy, 35(12), pp. 6397–6412. Available at: https://doi.org/10.1007/s00464-021-08658-w.
Zhou, H. et al. (2021) ‘The impact of pharmacist intervention on prophylactic antibiotics use in orthopedic surgery at a hospital in China’, Medicine, 100(52), p. e28458. Available at: https://doi.org/10.1097/MD.0000000000028458.
